Copy of Abdominal Pain
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- Abdominal pain is a common symptom with many possible causes, ranging from digestive issues to infections. When evaluating abdominal pain, the location, duration, intensity, and associated symptoms provide clues to help identify the underlying cause.
- Diverticulitis occurs when small pouches (diverticula) in the intestinal wall become inflamed or infected. It is often associated with left lower quadrant pain, fever, nausea, and changes in bowel habits. People with diverticulitis may also experience elevated white blood cell counts due to inflammation or infection.
- Appendicitis involves inflammation of the appendix, typically causing right lower quadrant abdominal pain. However, if the appendix is located in an unusual position, pain can be felt elsewhere. It is usually accompanied by fever, elevated white blood cell count, and sometimes nausea and vomiting.
- Ulcerative colitis is a chronic inflammatory bowel disease that affects the colon, characterized by symptoms such as bloody diarrhea, abdominal cramping, and urgency to have a bowel movement. Unlike diverticulitis and appendicitis, ulcerative colitis usually has a more prolonged course and is not typically associated with sudden severe abdominal pain.
Liver cirrhosis:
Liver cirrhosis is a chronic, progressive condition where healthy liver tissue is gradually replaced by scar tissue (fibrosis). This change disrupts the liver’s ability to perform essential functions like producing proteins, detoxifying substances, and regulating blood clotting.
Common risk factors include excessive alcohol consumption, chronic hepatitis infections (such as Hepatitis C), and metabolic disorders. Substance use and hyperlipidemia can further accelerate the progression of the disease.
Typical symptoms can vary depending on the stage but often include fatigue, weight loss, jaundice (yellowing of the skin and eyes), ascites (fluid buildup in the abdomen), and edema (swelling, particularly in the legs).
Serious complications can arise, such as portal hypertension, hepatic encephalopathy, spontaneous bacterial peritonitis (SBP), and liver failure. SBP is an infection of the fluid in the abdomen and is a life-threatening complication.
Managing ascites often involves paracentesis, a procedure to drain excess fluid from the abdomen. Missing a scheduled paracentesis can lead to increased abdominal pressure, worsening discomfort, and difficulty breathing.
Fever in cirrhosis patients can be a sign of an underlying infection. Infections are more common in these patients due to immunosuppression associated with liver dysfunction.
Monitoring vital signs is crucial, as changes in parameters like respiratory rate and temperature can signal emerging complications that need immediate medical attention.
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Question 1 of 9
1. Question
Item 1 of 6
The nurse in the emergency department is caring for a 72-year-old male client.
Category Details History and Physical A 72-year-old male client comes to the emergency department with left lower quadrant abdominal pain, nausea, and vomiting for the past 3 hours. Client has a history of obesity and hyperlipidemia. He denies previous gastrointestinal problems except occasional constipation. Client reports small streaks of blood present in the stool. He expresses pain level as 7/10 in lower left quadrant of abdomen. Pain is persistent without any radiation or alleviating factors. Abdominal tenderness noted on palpation of left lower quadrant. Bowel sounds are hypoactive. Client is alert and oriented to person, place, and time. Vital Signs at 1200 Temperature (T): 100.1 F (37.8 C)
Pulse (P): 104
Respiratory Rate (RR): 20
Blood Pressure (BP): 130/83 mmHg
Pulse Oximetry Reading: 97% on room airSelect the top 5 client findings that would require follow-up.
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Question 2 of 9
2. Question
2 of 6
The nurse reviews the client’s Laboratory Results from 1200.
History and Physical A 72-year-old male client comes to the emergency department with left lower quadrant abdominal pain, nausea, and vomiting for the past 3 hours. Client has a history of obesity and hyperlipidemia. He denies previous gastrointestinal problems except occasional constipation. Client reports small streaks of blood present in the stool. He expresses pain level as 7/10 in lower left quadrant of abdomen. Pain is persistent without any radiation or alleviating factors. Abdominal tenderness noted on palpation of left lower quadrant. Bowel sounds are hypoactive. Client is alert and oriented to person, place, and time. Vital Signs at 1200 Temperature (T) 100.1 F (37.8 C) Pulse (P) 104 Respiratory Rate (RR) 20 Blood Pressure (BP) 130/83 mmHg Pulse Oximetry Reading 97% on room air Laboratory Results at 1200 White Blood Cell (WBC) Count Normal: 5,000–10,000/mm3 (5.0-10.0 x 109/L)
Result: 15,600/mm3 (15.6 x 109/L)Hemoglobin Male: 14–18 g/dL (140-180 g/L)
Result: 15.5 g/dL (155 g/L)Platelets Normal: 150–400 × 103/μL (150-400 x 109/L)
Result: 250 x 103/μL (250 x 109/L)For each client finding below, specify if the finding is consistent with the disease process of diverticulitis, appendicitis, or ulcerative colitis. Each finding may support more than one disease process.
Client Findings Diverticulitis Appendicitis Ulcerative Colitis Fever Blood in stool More common in elderly clients Abdominal tenderness to palpation Left lower quadrant abdominal pain For each client finding specify if the finding is consistent with diverticulitis. Select all that apply
CorrectIncorrect -
Question 3 of 9
3. Question
2 of 6
The nurse reviews the client’s Laboratory Results from 1200.
History and Physical A 72-year-old male client comes to the emergency department with left lower quadrant abdominal pain, nausea, and vomiting for the past 3 hours. Client has a history of obesity and hyperlipidemia. He denies previous gastrointestinal problems except occasional constipation. Client reports small streaks of blood present in the stool. He expresses pain level as 7/10 in lower left quadrant of abdomen. Pain is persistent without any radiation or alleviating factors. Abdominal tenderness noted on palpation of left lower quadrant. Bowel sounds are hypoactive. Client is alert and oriented to person, place, and time. Vital Signs at 1200 Temperature (T) 100.1 F (37.8 C) Pulse (P) 104 Respiratory Rate (RR) 20 Blood Pressure (BP) 130/83 mmHg Pulse Oximetry Reading 97% on room air Laboratory Results at 1200 White Blood Cell (WBC) Count Normal: 5,000–10,000/mm3 (5.0-10.0 x 109/L)
Result: 15,600/mm3 (15.6 x 109/L)Hemoglobin Male: 14–18 g/dL (140-180 g/L)
Result: 15.5 g/dL (155 g/L)Platelets Normal: 150–400 × 103/μL (150-400 x 109/L)
Result: 250 x 103/μL (250 x 109/L)For each client finding below, specify if the finding is consistent with the disease process of diverticulitis, appendicitis, or ulcerative colitis. Each finding may support more than one disease process.
Client Findings Diverticulitis Appendicitis Ulcerative Colitis Fever ✔ Blood in stool ✔ More common in elderly clients ✔ Abdominal tenderness to palpation ✔ Left lower quadrant abdominal pain ✔ For each client finding specify if the finding is consistent with Appendicitis. Select all that apply
CorrectIncorrect -
Question 4 of 9
4. Question
2 of 6
The nurse reviews the client’s Laboratory Results from 1200.
History and Physical A 72-year-old male client comes to the emergency department with left lower quadrant abdominal pain, nausea, and vomiting for the past 3 hours. Client has a history of obesity and hyperlipidemia. He denies previous gastrointestinal problems except occasional constipation. Client reports small streaks of blood present in the stool. He expresses pain level as 7/10 in lower left quadrant of abdomen. Pain is persistent without any radiation or alleviating factors. Abdominal tenderness noted on palpation of left lower quadrant. Bowel sounds are hypoactive. Client is alert and oriented to person, place, and time. Vital Signs at 1200 Temperature (T) 100.1 F (37.8 C) Pulse (P) 104 Respiratory Rate (RR) 20 Blood Pressure (BP) 130/83 mmHg Pulse Oximetry Reading 97% on room air Laboratory Results at 1200 White Blood Cell (WBC) Count Normal: 5,000–10,000/mm3 (5.0-10.0 x 109/L)
Result: 15,600/mm3 (15.6 x 109/L)Hemoglobin Male: 14–18 g/dL (140-180 g/L)
Result: 15.5 g/dL (155 g/L)Platelets Normal: 150–400 × 103/μL (150-400 x 109/L)
Result: 250 x 103/μL (250 x 109/L)For each client finding below, specify if the finding is consistent with the disease process of diverticulitis, appendicitis, or ulcerative colitis. Each finding may support more than one disease process.
Client Findings Diverticulitis Appendicitis Ulcerative Colitis Fever ✔ ✔ Blood in stool ✔ More common in elderly clients ✔ Abdominal tenderness to palpation ✔ ✔ Left lower quadrant abdominal pain ✔ For each client finding specify if the finding is consistent with Ulcerative Colitis. Select all that apply
CorrectIncorrect -
Question 5 of 9
5. Question
Item 3 of 6
The nurse in the emergency department is caring for a 72-year-old male client.
The nurse reviews the client’s Laboratory Results from 1200.
History and Physical A 72-year-old male client comes to the emergency department with left lower quadrant abdominal pain, nausea, and vomiting for the past 3 hours. Client has a history of obesity and hyperlipidemia. He denies previous gastrointestinal problems except occasional constipation. Client reports small streaks of blood present in the stool. He expresses pain level as 7/10 in lower left quadrant of abdomen. Pain is persistent without any radiation or alleviating factors. Abdominal tenderness noted on palpation of left lower quadrant. Bowel sounds are hypoactive. Client is alert and oriented to person, place, and time. Vital Signs at 1200 Temperature (T) 100.1 F (37.8 C) Pulse (P) 104 Respiratory Rate (RR) 20 Blood Pressure (BP) 130/83 mmHg Pulse Oximetry Reading 97% on room air Laboratory Results at 1200 White Blood Cell (WBC) Count Normal: 5,000–10,000/mm3 (5.0-10.0 x 109/L)
Result: 15,600/mm3 (15.6 x 109/L)Hemoglobin Male: 14–18 g/dL (140-180 g/L)
Result: 15.5 g/dL (155 g/L)Platelets Normal: 150–400 × 103/μL (150-400 x 109/L)
Result: 250 x 103/μL (250 x 109/L)Diagnostic Results Computed tomography (CT) scan of the abdomen and pelvis with IV contrast 1210: Colonic wall thickening, pericolic fat stranding, and sigmoid diverticula consistent with colonic diverticulitis.
The nurse is most concerned about the client’s risk for developing?
CorrectIncorrect -
Question 6 of 9
6. Question
Item 4 of 6
The nurse in the emergency department is caring for a 72-year-old male client.
The nurse reviews the client’s Laboratory Results from 1200.
History and Physical A 72-year-old male client comes to the emergency department with left lower quadrant abdominal pain, nausea, and vomiting for the past 3 hours. Client has a history of obesity and hyperlipidemia. He denies previous gastrointestinal problems except occasional constipation. Client reports small streaks of blood present in the stool. He expresses pain level as 7/10 in lower left quadrant of abdomen. Pain is persistent without any radiation or alleviating factors. Abdominal tenderness noted on palpation of left lower quadrant. Bowel sounds are hypoactive. Client is alert and oriented to person, place, and time. Vital Signs at 1200 Temperature (T) 100.1 F (37.8 C) Pulse (P) 104 Respiratory Rate (RR) 20 Blood Pressure (BP) 130/83 mmHg Pulse Oximetry Reading 97% on room air Laboratory Results at 1200 White Blood Cell (WBC) Count Normal: 5,000–10,000/mm3 (5.0-10.0 x 109/L)
Result: 15,600/mm3 (15.6 x 109/L)Hemoglobin Male: 14–18 g/dL (140-180 g/L)
Result: 15.5 g/dL (155 g/L)Platelets Normal: 150–400 × 103/μL (150-400 x 109/L)
Result: 250 x 103/μL (250 x 109/L)Diagnostic Results Computed tomography (CT) scan of the abdomen and pelvis with IV contrast 1210: Colonic wall thickening, pericolic fat stranding, and sigmoid diverticula consistent with colonic diverticulitis.
Nurses’ Notes Day 1
1215:
Client returned from CT scan and asked to use the bathroom. He had one small, brown, loose stool with streaks of bright red blood. Assisted the client back to bed. He reported that moving around and using the bathroom made his pain worse. Reports pain is now 8/10 in severity. He is diaphoretic, nauseous, guarding his lower abdomen, and asking for pain medicine. Provided client with an emesis basin. Paged healthcare provider; awaiting new orders.The nurse reviews the Nurses’ Notes and Vital Signs from 1215.
For each potential order, click to specify whether the potential order is anticipated for the client.
CorrectIncorrect -
Question 7 of 9
7. Question
Item 5 of 6
The nurse in the emergency department is caring for a 72-year-old male client.
History and Physical A 72-year-old male client comes to the emergency department with left lower quadrant abdominal pain, nausea, and vomiting for the past 3 hours. Client has a history of obesity and hyperlipidemia. He denies previous gastrointestinal problems except occasional constipation. Client reports small streaks of blood present in the stool. He expresses pain level as 7/10 in lower left quadrant of abdomen. Pain is persistent without any radiation or alleviating factors. Abdominal tenderness noted on palpation of left lower quadrant. Bowel sounds are hypoactive. Client is alert and oriented to person, place, and time. Vital Signs at 1200 Temperature (T) 100.1 F (37.8 C) Pulse (P) 104 Respiratory Rate (RR) 20 Blood Pressure (BP) 130/83 mmHg Pulse Oximetry Reading 97% on room air Laboratory Results at 1200 White Blood Cell (WBC) Count Normal: 5,000–10,000/mm3 (5.0-10.0 x 109/L)
Result: 15,600/mm3 (15.6 x 109/L)Hemoglobin Male: 14–18 g/dL (140-180 g/L)
Result: 15.5 g/dL (155 g/L)Platelets Normal: 150–400 × 103/μL (150-400 x 109/L)
Result: 250 x 103/μL (250 x 109/L)Diagnostic Results Computed tomography (CT) scan of the abdomen and pelvis with IV contrast 1210: Colonic wall thickening, pericolic fat stranding, and sigmoid diverticula consistent with colonic diverticulitis.
Nurses’ Notes Day 1
1215:
Client returned from CT scan and asked to use the bathroom. He had one small, brown, loose stool with streaks of bright red blood. Assisted the client back to bed. He reported that moving around and using the bathroom made his pain worse. Reports pain is now 8/10 in severity. He is diaphoretic, nauseous, guarding his lower abdomen, and asking for pain medicine. Provided client with an emesis basin. Paged healthcare provider; awaiting new orders.Orders
- Maintain NPO status
- Insert nasogastric tube to low intermittent suction
- Piperacillin-tazobactam 3.375 g IV every 6 hours
- Lactated Ringer’s continuous IV infusion at 125 mL/hr
- Morphine 2 mg IV every 4 hours as needed for pain 8-10/10
- Ondansetron 4 mg IV every 4 hours as needed for nausea and vomiting
To address the client’s symptoms, the nurse should first ___________ Next, the nurse can ___________. Choose the the 2 correct options.
CorrectIncorrect -
Question 8 of 9
8. Question
Item 6 of 6
The nurse in the emergency department is caring for a 72-year-old male client.
History and Physical A 72-year-old male client comes to the emergency department with left lower quadrant abdominal pain, nausea, and vomiting for the past 3 hours. Client has a history of obesity and hyperlipidemia. He denies previous gastrointestinal problems except occasional constipation. Client reports small streaks of blood present in the stool. He expresses pain level as 7/10 in lower left quadrant of abdomen. Pain is persistent without any radiation or alleviating factors. Abdominal tenderness noted on palpation of left lower quadrant. Bowel sounds are hypoactive. Client is alert and oriented to person, place, and time. Vital Signs at 1215 Temperature (T) 100.8 F (38.2 C) Pulse (P) 108 Respiratory Rate (RR) 21 Blood Pressure (BP) 138/76 mmHg Pulse Oximetry Reading 98% on room air Laboratory Results at 1200 White Blood Cell (WBC) Count Normal: 5,000–10,000/mm3 (5.0-10.0 x 109/L)
Result: 15,600/mm3 (15.6 x 109/L)Hemoglobin Male: 14–18 g/dL (140-180 g/L)
Result: 15.5 g/dL (155 g/L)Platelets Normal: 150–400 × 103/μL (150-400 x 109/L)
Result: 250 x 103/μL (250 x 109/L)Diagnostic Results Computed tomography (CT) scan of the abdomen and pelvis with IV contrast 1210: Colonic wall thickening, pericolic fat stranding, and sigmoid diverticula consistent with colonic diverticulitis.
Nurses’ Notes Day 1
1215:
Client returned from CT scan and asked to use the bathroom. He had one small, brown, loose stool with streaks of bright red blood. Assisted the client back to bed. He reported that moving around and using the bathroom made his pain worse. Reports pain is now 8/10 in severity. He is diaphoretic, nauseous, guarding his lower abdomen, and asking for pain medicine. Provided client with an emesis basin. Paged healthcare provider; awaiting new orders.Orders
- Maintain NPO status
- Insert nasogastric tube to low intermittent suction
- Piperacillin-tazobactam 3.375 g IV every 6 hours
- Lactated Ringer’s continuous IV infusion at 125 mL/hr
- Morphine 2 mg IV every 4 hours as needed for pain 8-10/10
- Ondansetron 4 mg IV every 4 hours as needed for nausea and vomiting
For each assessment finding, click to specify if the finding indicates that the client’s condition has improved.
CorrectIncorrect -
Question 9 of 9
9. Question
The emergency department (ED) nurse is caring for a client with liver cirrhosis
Item 1 of 1
Nurses’ Note Client Information 57-year-old male reporting increasing dyspnea and abdominal pressure after missing his previously scheduled paracentesis. The client reports he feels ‘uncomfortable.’ He is alert and oriented x 4; sclera is yellow along with jaundice skin appearance. Respirations were labored, tachypnea, and clear breath sounds. Abdominal distention noted, hypoactive bowel sounds in all four quadrants. Ascites and dependent edema were noted. Peripheral pulses were intact. Medical History Hepatitis C
Liver cirrhosis
Substance use disorder
HyperlipidemiaVital Signs Oral Temperature 101°F (38.3°C) Heart Rate 94/minute Respirations 24/minute Blood Pressure 104/68 mm Hg Oxygen Saturation 95% on room air Which assessment findings require follow-up? Select all that apply.
CorrectIncorrect